California Health Insurance Consumer Guide

In order to sign up for private health coverage through Covered California, you must:⁷

• Be a California resident
• Not be incarcerated
• Not be enrolled in Medicare
• Be lawfully present in the United States (California has been expanding access to Medi-Cal for low-income undocumented residents. This will apply to all age groups by 2024.)⁸

By those rules, most Californians can enroll in coverage through the exchange. But a bigger question for most people is financial assistance, and there are a few additional parameters in order to be eligible for subsidies through Covered California. To qualify for income-based Advance Premium Tax Credits (APTC), federal cost-sharing reductions (CSR), or California’s new state-funded cost-sharing subsidies, you must:

• Not have access to affordable health coverage through an employer. If you have access to an employer’s plan but it seems too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies via Covered California. 
• Not be eligible for Medi-Cal (California Medicaid).

Beyond those basic parameters, qualifying for Covered California subsidies will depend on how much your household earns and how that compares with the cost of the second-lowest-cost Silver plan in your area (the cost of this plan will depend on your age and location).

California’s open enrollment period is longer than the window used in most other states. It begins November 1 and continues through January 31.⁹ This window is your opportunity to select a new plan or switch to a different plan. The enrollment window is applicable to plans obtained via Covered California or directly from an insurer, but note that subsidies are only available through Covered California.

For coverage to take effect on January 1, you need to complete your application by December 31. (This is later than the deadline in many other states.) If you enroll between January 1 and January 31, your coverage will take effect on February 1.¹⁰

After the annual open enrollment window ends, you may still be eligible to enroll or make a plan change if you experience a qualifying life event, such as giving birth or losing other health coverage. And some people can enroll year-round even without a specific qualifying life event.¹¹ 

Enrollment in Medi-Cal is available year-round.

To enroll in an ACA Marketplace/exchange plan in California, you can: 

• Visit Covered California, California’s health insurance exchange (Marketplace). Using this online platform, you can compare plans, determine whether you’re eligible for financial assistance, and enroll in coverage. 
• Enroll in a Covered California plan with the help of an insurance agent or certified enrollment counselor. ¹² Covered California has a “help on demand” program that allows you to submit your contact information and then receive a call from a certified enrollment assister who will help you sort out the details.
  

You can reach the Covered California call center at 1-800-300-1506, Monday to Friday between 8 am and 6 pm.

The Affordable Care Act (ACA) provides income-based subsidies that can reduce the amount you pay for your coverage each month. These subsidies are available to applicants who meet the eligibility requirements and enroll in a health plan through Covered California.

More than 80% of Covered California enrollees were receiving premium subsidies as of early 2023. These subsidies averaged $486/month, and after the subsidies were applied, the average enrollee’s premium was about $134/month.¹³ 

If your household income isn’t more than 250% of the federal poverty level, you’ll also be eligible for federal cost-sharing reductions (CSR), which will reduce your deductible and other out-of-pocket expenses. These benefits are built into Silver-level plans if the applicant is eligible for them. Forty-one percent of Covered California enrollees were receiving CSR benefits as of 2023.¹⁴ 

And as of 2024, California will supplement the federal CSR benefits with additional state-funded cost-sharing subsidies. Eligible Silver-plan enrollees will have $0 deductibles and lower costs for other out-of-pocket expenses.¹⁵ 

Covered California and Medi-Cal (California Medicaid) use the same application, and the system will let you know whether you’re eligible for Medi-Cal or a private plan through Covered California – with subsidies if you qualify for them.

Source: CMS.gov ¹⁶

For 2024 coverage, 12 insurers will offer plans through California’s exchange. This is the same as the number of participating insurers in 2023, but there will be one insurer exit at the end of 2023 and one newcomer for 2024:¹⁷ 

• Aetna CVS Health 
• Anthem Blue Cross of California (plans available statewide)
• Blue Shield of California (plans available statewide)
• Chinese Community Health Plan
• Health Net
• Inland Empire Health Plan (new for 2024)
• Kaiser Permanente
• L.A. Care Health Plan
• Molina Healthcare
• Sharp Health Plan
• Valley Health Plan
• Western Health Advantage

Oscar Health Plan of California offers plans through Covered California in 2023, but is leaving the market at the end of 2023.¹⁷ 

Covered California’s insurers have filed the following preliminary rate changes for 2024:¹⁷ 

Source: Covered California¹⁷

It’s important to remember that average rate changes are for full-price plans, and most enrollees do not pay full price: Ninety percent of Covered California enrollees were receiving premium subsidies in 2023, to offset some or all of their monthly payments.¹⁸ 

The subsidy amount is different for each enrollee and changes each year depending on the cost of the second-lowest-cost Silver plan relative to the enrollee’s household income. Under the American Rescue Plan and the Inflation Reduction Act, subsidies are larger and more widely available than they used to be, and that will continue to be true at least through 2025.

Full-price premium changes depend on the specific plan (for each insurer, premium changes vary from one plan to another), as well as the enrollee’s age and zip code.

So for the majority of Covered California enrollees, net premium changes depend on how their specific plan’s rate changes, as well as year-over-year changes in their subsidy amount. 

If the cost of your current plan is increasing for the coming year, you may want to consider some of the other plans that are available via Covered California. You might find some that are less expensive and offer similar benefits.

During the open enrollment period for 2023 coverage, 1,739,368 people selected private plans through Covered California.¹⁹

Effectuated enrollment totals are always lower than the number of people who sign up during open enrollment. CMS reported that 1,701,375 people had effectuated coverage through Covered California as of early 2023.²⁰

Source: 2014,²¹ 2015, ²² 2016,²³ 2017,²⁴ 2018,²⁵ 2019,²⁶ 2020,²⁷ 2021,²⁸ 2022,²⁹ 2023,³⁰ 2024³¹

Covered California: This is California’s Marketplace/exchange. Residents can use Covered California to enroll in individual/family health plans and receive income-based subsidies, and also to enroll in Medi-Cal. You can contact Covered California at 800-300-1506.

California Department of Health Care Services: The agency that administers Medi-Cal and various other health care programs. 

California Department of Managed Health Care (DMHC): Regulates the vast majority of California’s commercial (non-self-insured) health plans, and assists consumers and businesses with insurance-related questions and concerns. 

California Department of Insurance: Regulates California’s insurance plans that aren’t regulated by the Department of Managed Health Care. If a complaint or concern is filed with the DMHC and it’s for a product that’s regulated by the Department of Insurance, it will be forwarded to the Department of Insurance.

California Health Insurance Counseling and Advocacy Program (HICAP): A service for California Medicare beneficiaries and their caregivers. HICAP provides information and assistance with questions related to Medicare eligibility, enrollment, and claims.